Improve flow of information between hospital and outpatient physicians and providers

Improve communication between providers and patients

Optimize discharge processes

Background

According to research published in the New England Journal of Medicine, about 1 in 5 hospitalized Medicare beneficiaries were readmitted within 30 days after discharge. Unplanned re‐hospitalizations may cost Medicare $17.4 billion or more. The Hospital Readmission Reduction Program in the Affordable Care Act Penalizes hospitals with higher than expected 30 day readmission rates.

Project BOOST was led by a national advisory board of recognized leaders in care transitions, hospital medicine, payers and regulatoryagencies. The board was co‐chaired by Eric Coleman MD, MPH and Mark Williams, MD, FACP, MHM and included representatives from the Agency for Healthcare Research and Quality (AHRQ), Blue Cross and Blue Shield Association, Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, Institute for Health Care Improvement (IHI), The Joint Commission, and Kaiser Permanente. Medical, pharmacy and nursing professional societies, and patient advocates participate and contribute to Project BOOST’s development.

Project BOOST's 5 Key Elements:

A Comprehensive Intervention developed by a panel of nationally recognized experts based on the best available evidence.

A Comprehensive Implementation Guide provides step‐by‐step instructions and project management tools, such as the Teach Back Training Curriculum, to help interdisciplinary teams redesign hospital discharge work flow, as well as plan, implement, and evaluate the intervention.

Longitudinal Technical Assistance provides face‐to‐face training and a year of expert mentoring and coaching to customize and implement BOOST interventions. Mentors guide local teams to build a culture that supports safe and complete transitions through monthly coaching calls with their mentor. Teams receive a train‐the‐trainer DVD and curriculum for nurses and case managers on using the Teach Back process. Quarterly all‐site teleconferences and webinars target the educational needs of other team members including administrators, data analysts, physicians, nurses and others.

The BOOST Online Community allows sites to communicate with and learn from each other via the BOOST Listserv, document and resource sharing. Currently, over 165 sites and 1000 individual users participate.

The BOOST Data Center allows sites to store and benchmark data against control units and other sites and generates reports.

Analysis

As of February 2014, the project BOOST toolkit has been downloaded over 6,000 times from the SHM website. The year‐long mentoring program providing expert coaching to implement the program has been implemented at 180 hospital sites.

Project BOOST mentor sites are in various stages of planning implementation and data reporting. Aggregate findings for sites with an intervention in place for one year will be available in mid‐2013 (in press). Early data from six sites, which implemented Project BOOST, revealed a reduction in their 30 day readmission rates from 14.7% before BOOST to 12.7% after implementation; also, producing a 13.6% reduction in 30 day all‐cause readmission rates.

Pilot sites indicate that BOOST tools are well received by health care teams and patients as it improved communication and collaboration across the hospital and with outpatient physicians. Patients reported a very positive response to what they perceive as an increased level of service and medical attention.

Funding

Project BOOST was developed through a $1.4 million grant from The John A. Hartford Foundation.

SHM continues to fund the collaborative through the following programs:

BCBS of Michigan

BCBS of Illinois

Beacon Communities of Hawaii / Hilo Medical Center

Hospital Association of Pennsylvania

LACare & Hospital Association of Southern California

South Carolina Partnership for Health

Individual Tuition-Based Hospitals

Paritcipating Mentor Sites:

There are currently over 180 mentor sites, located in 31 United States with an additional mentor site in Canada.

Arizona

Kansas

Mississippi

New York

Texas

California

Louisiana

Missouri

North Carolina

Vermont

Connecticut

Maine

Montana

Pennsylvania

Virginia

Florida

Massachusetts

New Hampshire

South Carolina

Washington

Georgia

Michigan

New Jersey

South Dakota

Washington, D.C.

Hawaii

Minnesota

New Mexico

Tennessee

Wisconsin

Illinois

Project BOOST and the Affordable Care Act

Project BOOST is an effective tool for reducing unnecessary readmissions and improving transitions of care. It provides a foundation for and complements initiatives such as Dr. Eric Coleman’s Care Transitions Program or Dr. Mary Naylor’s Transitions of Care Model.

FY2013: Inpatient PPS hospitals with higher‐than‐expected readmissions rates will experience decreased Medicare payments for all Medicare discharges. Evaluation will be based on the 30‐day re‐admission measures for heart attack, heart failure and pneumonia that are currently part of the Medicare pay‐for‐reporting program and reported on Hospital Compare.

FY2015: The list of conditions can be expanded to include COPD and several cardiac and vascular surgical procedures, as well as, any other condition or procedure the Secretary chooses.

Disclaimer
The implementation toolkit is an online resource for visitors to the Society of Hospital Medicine's website. All content and links have been reviewed by the BOOST Project Team, however the Society of Hospital Medicine does not exercise any editorial control over content associated with the external links that have been made available via this website.